Neuro E1 Flashcards
Primary Headache Disorders 4
Migraine
Tension-Type Headache
Cluster Headache
Hemicrania Continua
Secondary Headache Disorders 7
Traumatic Brain Injury Headache
Pseudotumor Cerebri
Brain Tumor Headache
Reversible Cerebral Vasoconstriction Syndrome
Subarachnoid Headache
Medication Overuse Headache
Substance Withdrawal Headache
Migraine Aura Chateristics
- Gradual onset/evolution of positive visual symptoms (shimmering lights, zigzags in vision, tingling)
- Sequential progression (positive symptoms first then negative symptoms) OR repetitive attacks of identical nature
- Flurry of attacks midlife
- <60mins
- 50% chance HA follows
Transient Ischemic Attack (TIA)
- Abrupt visual loss
- Simultaneous occurance of multiple neurological symptoms (vision loss and arm feeling numb at the same time)
- < 15 mins
- HA does not accompany
Diclofenac potassium oral solution (Cambia)
Solution NSAID (faster absp)
Needs to be mixed with 1 - 2 oz of water prior to admin
Celecoxib oral solution (Elyxyb)
Solution NSAID (faster absp)
Butalbital/APAP/Caffeine (Fioricet, Bac, Esgic, Zebutal)
NON CONTROLLED
Butalbital is a barbiturate, thus abuse potential
BBW for hepatotoxicity because of APAP
Can depress sensory cortex/alter cerebela function
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month
Butalbital/ASA/Caffeine (Fiorinal)
C3
LAST LINE TX MEDICATION OVERUSE HEADACHE, limit to 3days/month
Triptans use and CI in what
FOR ACUTE TREATMENT ONLY, early administration for best response
Contraindicated in stroke/tia patients (so if s/sx show history then don’t use), no use within 24hrs of an ergot
Simple Partial Seizures Definition
NO impairement of consciousness
Associated with motor signs, sensory and somatosensory signs, autonomic signs
Complex partial seizures Definition
WITH impairment of consciousness, not LOSS of consciousness
Patient may present as if with a psych disorder
Generalized Seizures Definition
Tonic-clonic (involuntary muscle loss - convulsing)
All of the cerebral cortex is involved, a CORTICOL event
Abscence Seisures Definition
Only happens in childhood and early adolescence
Difference between Seizure and Epilepsy
Epilesy is a disorder of continued seizures
If seizures are caused as a side effect of recrational and illegal meds then it can progress to epilepsy.
Prego OK Seizure Rx
PLFEO (pregnant ladies feel especially obese)
Phenobarbital (a barbituate so expect baby to withdraw)
Oxcarbamazepine
Lamotrigine
Ethosuximide
Folic Acid Supplement
Nursing NOT OK Seizure Rx
Phenobarbital because the baby can become addicted
All other drugs actual newborn dose is negligible.
Prolongation of Na Channel INACTIVATION
Sodium Valproate
Carbamazepine
Phenytoin
Topiramate
Zonisamide
Lamotrigine
Shit Crap, Phinease Took Zoo Lamps
Inhibition of Ca Channel Current
Sodium Valproate
Ethosuzimide
Trimethadione
SET (inhibiting anyone coming in)
Faciliation of GABA mediated Cl Channel Opening
Barbiturate
Benzodiazepine
Vigabatrin
Sodium Valproate
Gabapentin
Tiagabine
Ben and Barb, So Very Good Tia
Organ Systems Effected by CHRONIC XS USE
CNS Effects
- Addiction
- Wernicke-Korsakoff Syndrome
- Cortical Atrophy/Dementia
Hepatic/Pancreatic
- Steatosis (Fatty Liver)
- Alcoholic hepatitis
- Cirrhosis
- Pancreatitis
Sensitization
Increased response to a drug with repeated use Shifting Dose Response Curve to the left
Tolerance
a state of adaptation in which
exposure to a drug induces changes that
result in a diminution of one or more of the
drug’s effect over time
Shifting Dose Response Curve to the right
Addiction
a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations
Drug Abuse
maladaptive pattern of substance use characterized by repeated adverse consequences related to the repeated use of the substance
Dependence
Body adapts to presence of drug. Needs drug on board to maintain homeostasis
Sublocade Clinical Benefits of SQ injection once a month
- Reducing the diversion and abuse/nonmedical use when compared to SL tablet or film form
- Useful in noncompliant patients because no need to take a SL tablet or film once or twice a day
Sublocade BBW
Serious harm or death if admin IV/IM because it forms a block upon contact with body fluids HENCE REMS PROGRAM
Sublocade admin doses ____days apart
26
Stimulants Examples
Cocaine
Amphetamine
Methamphetamine
PCP
Ketamine
Eletriptan CP
CI in potent CYP3A4 inhibitors needs 72hrs washout (like ketoconazole, clarithromycin, Nafazidome, and ritonavir)
Most lipophilic (can cross the BBB so more CNS Effects, but less recurrence)
Frovatriptan CP
Longest half life, ONLY TRIPTAN OKAY FOR PREVENTION IN MENSTRUAL HEADACHES
Sumatriptan CP
Intranasal, SQ, and PO formulations
Intranasal»_space; SQ > PO for onset of action
Sumatriptan chest pain is most common with SQ, so just change to a different formulation if it’s a side effect issue
CGRP Mabs
Eptinezumab
Erenumab
Fremanezumab
Galcanezumab
Which of the CGRP mabs are a CGRP receptor?
Erenumab, others are CGRP ligands
Eptinezumab Route of Administration and freq
IV q 3 months
Erenumab Route of Administration and freq
SQ every month
Fremanezumab Route of Administration and freq
SQ every month OR every 3 months
Galcanezumab Route of Administration and freq
SQ every month
Eptinezumab side effects
infusion reaction
Nasopharyngitis
Nausea
Erenumab side effects
Injection site reaction
Constipation*** if its really bad may need to be hospitalized, consider if there are other drugs on board that are causing low GI motility
Fremanezumab side effects
injection site reaction
Galcanezumab side effects
injection site reaction
Magnesium use and ADE
migraine prophylaxis, rec in prego
ADE: Diarrhea, N/V
Feverfew use and ADE
migraine prophylaxis, AVOID IN PREGO BECAUSE MAY CAUSE UTERINE CONTRACTIONS AND ABORTIONS
ADE: GI issues (stomach pain, bloating, constipation, diarrhea, flatulence, heartburn, nausea)
Butterbur use and ADE
migraine prophylaxis
AVOID PRODUCTS THAT ARE NOT LABELED AS PA FREE (PYRROLIZIDINE ALKALOIDS)
ADE: GI issues (belching, diarrhea, stomach upset), drowsy, fatigue, pruritus, rash, hepatotoxicity (rare)
Botox use, BBW, ADE
for Chronic migraines
BBW: Spread of toxin effect - muscle weakness, diplopia (double vision), ptosis (eyelid drooping), dysphagia (can’t swallow), breathing issues
ADE: injection site pain, neck pain, myalgia (muscle pain), facial paresis (face paralysis)
Lasmiditan clinical pearl and ehat level of control?
C5
And must wait 8hrs between dosing and driving heavy machinery because of profound cns depression
Topiramate ADE
Cognitive dysfunction
CNS Effects
Nephrolithiasis
Metabolic acidosis
Angle closure glaucoma
Oligohydrosis/hyperthermia (no sweating)
Suicidal ideation
Sodium valproate BBW
Hepatotoxicity
Pts with mitochondrial disease
Fetal risk
Pancreatitis
Tricyclic antidepressants use and ade
Used in preventative migraine TX, #4
Ade, anticholinergic effects, cardiac conduction abnormalities
Opioid effects of use
Euphoria
Dysphoria
Apathy
Motor retardation
Sedation
Slurred speech
Attention impairment
Miosis
Constipation
